<style>
    .layui-iconpicker-body.layui-iconpicker-body-page .hide {
        display: none;
    }
    .select_a {
            color: #009688;
            padding: 2px;
            margin: 2px;
            border: #009688 1px dashed;
        }
</style>
<link rel="stylesheet" href="__STATIC__/plugs/lay-module/autocomplete/autocomplete.css?v={$version}" media="all">
<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
                <div class="layui-form-item">
            <label class="layui-form-label">病症名称</label>
            <div class="layui-input-block">
                <input type="text" id="name" name="name" class="layui-input" lay-reqtext="请输入病症名称" placeholder="请输入病症名称" value="{$row.name|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">排序</label>
            <div class="layui-input-block">
                <input type="text" id="sort" name="sort" class="layui-input" lay-reqtext="请输入排序" placeholder="请输入排序" value="{$row.sort|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">病症添加金额</label>
            <div class="layui-input-block">
                <input type="text" id="money" name="money" class="layui-input" lay-reqtext="请输入病症添加金额" placeholder="请输入病症添加金额" value="{$row.money|default=''}">
                <tip>正为加钱，负为减钱</tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">病症类型</label>
            <div class="layui-input-block">
                <select name="option_type_id" class="layui-select" lay-search>
                    <option value="">请选择</option>
                    {foreach $alldata['field']['option_type_id']['option'] as $key=>$vo}
                    <option value="{$vo.id}" {if $vo.id==$row.option_type_id}selected{/if}>{$vo.name|raw}</option>
                    {/foreach}
                </select>
                <tip></tip>
                </div>
        </div>
<input type="hidden" name="nursing_lang_id" value="{$row.nursing_lang_id|default=''}">
        <div class="layui-form-item">
            <label class="layui-form-label">展示到列表</label>
            <div class="layui-input-block">
                <input name="is_default" value="1" type="checkbox" class="switch" lay-skin="switch" lay-text="开启|关闭" {if $row.is_default==1}checked=""{/if}>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">状态</label>
            <div class="layui-input-block">
                <input name="status" value="1" type="checkbox" class="switch" lay-skin="switch" lay-text="开启|关闭" {if $row.status==1}checked=""{/if}>
            </div>
        </div>

        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>
<script>
    var parameter = '{$parameter|raw|default=""}';
</script>